Antenatal Corticosteroid Use and Perinatal Mortality According to Gestational Age among Preterm Singletons Born at 27 to 34 Weeks of Gestation in Hospitals in Tanzania

摘要

Background: Antenatal corticosteroid (ACS) treatment has been proven to decrease rates of adverse perinatal outcomes when administered to pregnant women at risk for preterm delivery. Given the uncertainty about the benefit of ACS according to gestational age, we aimed to examine whether there was any benefit of ACS on perinatal mortality and respiratory distress syndrome (RDS) according to different gestational ages at birth. Methods: Secondary analysis of data from an observational prospective chart review study was conducted in four hospitals located in the Mwanza region, Tanzania. The study population consisted of singleton infants delivered between 27 and 34 weeks of gestation between July 2019 and February 2020. Sociodemographic and medical data were recorded from participants’ medical records. Results: Over an eight-month period, 838 preterm singletons were delivered between 27 and 34 weeks of gestation. Three hundred and twelve (37.2%) pregnant women received at least one dose of ACS. Among infants exposed to ACS, perinatal mortality rates were significantly lower than those without exposure at the 27th week (27.8% vs 94.4%, P < 0.001), the 29th week (13.3% vs 51.4%, P = 0.012) and the 34th week (3.0% vs 18.2%, P < 0.001). Among infants exposed to ACS, the RDS rate was significantly lower than those without exposure only at the 32nd week (9.5% vs 25.0%, P = 0.039). Conclusion: Our findings add to the literature about the benefits of ACS for preterm infants of various gestational ages in low-resource settings. Compared to unexposed infants, those exposed to ACS and born at 27th and 34th weeks of gestation experienced lower rates of perinatal mortality. Future research, especially among infants born before the 27th week of pregnancy, is a priority.